HSE SOUTH Regional Service Plan 2012 9th February 2012 Contents Introduction to HSE South RSP 2012 ............................................................................................................ 2 Resource Framework...................................................................................................................................... 9 Improving Quality and Delivering Safe Services........................................................................................ 13 Service Delivery ............................................................................................................................................ 19 Promoting and Protecting Health...............................................................................................................................19 Primary Care, Community (Demand-Led) Schemes and other Community Services ...............................................24 Hospital Services.......................................................................................................................................................31 Cancer Services ........................................................................................................................................................51 Older People Services...............................................................................................................................................57 Mental Health Services..............................................................................................................................................64 Disability Services .....................................................................................................................................................76 Child Protection and Welfare Services ......................................................................................................................82 Palliative Care ...........................................................................................................................................................89 Social Inclusion..........................................................................................................................................................93 Appendices.................................................................................................................................................... 97 Appendix 1 – Financial Information ...........................................................................................................................97 Appendix 2 – HR Information ....................................................................................................................................98 Appendix 2 – Health Sector PSA Implementation Plan...........................................................................................100 Introduction - Regional Director of Operations The Chief Executive Officer, Mr Cathal Magee, published the HSE National Service Plan 2012 (NSP) on the 13th January, 2012, having been approved by the Minister for Health & Children. This HSE South Regional Service Plan has been prepared consistent with these national policies, frameworks, performance targets, standards & resources. The Regional Service Plan sets out the type and volume of service the HSE South will provide directly or through a range of agencies funded by us during 2012. Resources for 2012 A summary of the funding and staff numbers available to deliver the Regional Service Plan is outlined in the Resource Framework on the next section of the plan. The detail of funding, staff numbers and the service delivery plan for the year in each care group or service is outlined under each section of the plan. Finance While the gross reduction in budget for the HSE South in 2012 amounts to €208m, this does not represent the service impact this year. Comparisons between gross budget figures for 2011 and 2012 are difficult this year as there has been a significant reorganisation of some funding streams, e.g. Fair Deal has been centralised nationally. These changes together with the income measures and related issues amount to €142m which can be regarded as non-service impacting in 2012. Furthermore additional funding of €14m has been provided in respect of children’s services, to address some service pressures and to allow some limited and targeted recruitment in priority areas to help limit the impact of retirements on frontline services. When the budget is adjusted for these figures, the budget reduction for the South in 2012 which is service impacting amounts to €80m (3.7%). In addition the underlying deficit and service pressures from 2011, which will need to be addressed in 2012, amounts to €35m (1.8%), which presents a resource challenge of €115m (5.5%) for HSE South in 2012. Staff Numbers Apart from this overall budget reduction, a significant challenge for the HSE South in 2012 will be managing the reduction in levels of staff employed arising from the retirements associated with the grace period in February 2012. In addition, the government policy to reduce the size of the public sector and overall employment levels through the moratorium will continue. The cumulative impact on staff reductions from this year and previous years will present a significant challenge for the HSE South in delivering services. The reduction in staff numbers in HSE South over the past number of years can be summarised as follows: . 2,276 staff reduction since 2007 peak . 1,412 less staff at end 2011 than started 2010 . 1,000 staff left in 2011 The table below outlines the number of WTE staff who will be retiring on an area & care group basis from November 2011 to February 2012. It also identifies the numbers retiring as a percentage of our overall workforce. In all, this represents 736 individuals who have left since November 2011. A further 173 individuals had left the service between Sept to Nov 2011 (excluding Corporate and Home Helps) bringing the overall total to 909 individuals. WTE as % of Care Group CK/ST Cork Kerry WT/WX Total Care Group Resource Acute Hospitals 35 101 17 61 214 (2.0%) Children & Families 4 8 1 10 23 (2.3%) Disabilities 8 45 17 70 (2.1%) Mental Health 38 56 19 11 124 (4.9%) Older People 43 67 34 27 171 (5.2%) Primary Care 3 12 4 4 23 (1.8%) Social Inclusion 1 1 (0.9%) Grand Total 131 290 76 129 626 (2.8%) . 736 individuals equating to 626 WTE have notified that they will retire (in the period Nov11 to Feb12) – Nursing 371 WTE (4.3%) of which • Acute 114 WTE (2.6%) • Mental Health 97 WTE (6.3%) • SOP 124 WTE (7.5%) • Disabilities 30 WTE (3.7%) – General Support staff 69 WTE (2.5%) HSE South 2 INTRODUCTION – Other patient & Client Care (HCA’s) 60 WTE (1.9%) – Health & Social Care Professionals 55 WTE (1.7%) – Management / Admin 43 WTE (1.6%) – Medical Dental 29 WTE (1.7%) Responding to the Resource Challenge–Minimising impact on Frontline Services Work has been underway since Autumn 2011 in preparing for the reduction in staff numbers with many of these staff having retired which can be seen from the figures outlined above. This Regional Service Plan has been prepared taking account of the overall reduction in resources in terms of both budget reduction and staff numbers leaving. The HSE South is seeking to mitigate the impact of the retirements on frontline services in a number of ways: – by using the provision of the Public Service Agreement to bring about greater flexibilities in work practices and rosters, redeployment and other changes to achieve more efficient delivery of services. – Delivering greater productivity through the National Clinical Programmes to reduce the average length of stay, improve day of admission surgery rates, increase the numbers of patients treated as day cases, etc. – Some limited and targeted recruitment in priority areas to help limit the impact of retirements on frontline services. If we are to successfully implement the Regional Service Plan, the fundamental challenge for HSE South in 2012, is to: . Fast-track implementing our change programmes – New, innovative and efficient ways of using a reducing resource – Challenging traditional cost structures & models of service delivery – Implementing the health reform programme . Move to new models of care across all services & Care Groups which; – Deliver at the lowest level of complexity – Provide services at the lowest possible unit cost – Reorganisation of hospital services & implementing National Clinical Programmes – Improvement programmes across all Care Groups based on agreed national policies, e.g. Vision for Change, VFM report in Disability, Primary Care Strategy . Our HR Strategy and workforce plan will be implemented to ensure that staff resources are allocated to the area of greatest priority with a strong focus on – workforce planning – redeployment to match staffing resources with service & activity priorities – Review of rostering arrangements – Enhancing skill mix where appropriate in care areas Public Sector Agreement The Public Sector Agreement provides the framework for delivering on this significant change programme across the HSE South during the course of 2011. It provides a unique opportunity to further transform and modernise the health services by facilitating a reduction in staff numbers, increasing efficiency and productivity, reducing costs and improving quality. During 2012 there has been very positive engagement on implementing major change programmes across all four areas